PROJECT SUMMARY In South Africa, up to 40% of pregnant women are HIV-infected and 30-45% are obese. Obese women are at high risk for developing non-communicable diseases (NCDs), such as gestational diabetes mellitus or a hypertensive disorder in pregnancy (e.g. gestational hypertension, pre-eclampsia and eclampsia). NCDs in pregnancy increase the risk of adverse pregnancy outcomes and predispose both women and children to a higher risk of developing a NCD later in life, including obesity, Type 2 diabetes and cardiovascular disease. NCDs in pregnancy may be of special concern for HIV-infected women. In non-pregnant adults, HIV-infection and some types of antiretroviral therapy (ART) influence the development of adiposity, dyslipidemia, and insulin resistance and contribute to the development of hypertension and Type 2 diabetes ? but the impact of HIV on the development and impact of NCDs in pregnancy is not clear. For low- and middle-income countries (LMICs), such as South Africa, the high dual burden of HIV and NCDs in pregnancy is likely to strongly influence maternal and child health in the coming years. Data addressing the critical intersection of HIV and NCDs in pregnancy is urgently needed to guide the development of effective screening, referral, and clinical management strategies. Thus, we propose to enroll a cohort of 200 HIV-infected and 200 HIV-uninfected women (N=400) and follow them from pregnancy through 6 months postpartum. Women will be screened for gestational diabetes and hypertensive disorders in pregnancy. Pregnancy outcomes, including stillbirth, preterm birth, large- and small- for gestational age will be evaluated at birth. At 6 months postpartum we will evaluate maternal and NCD outcomes including obesity, hypertension, Types 2 diabetes and insulin resistance in women and infants (if relevant). The central objective of this proposal is to generate preliminary evidence on the burden and impact of NCDs and HIV in pregnancy and postpartum in LMICs and to build capacity for HIV and NCD research in LMICs. We will accomplish these objectives through the following specific aims: 1) Determine how HIV-status affects the risk of developing NCDs in pregnancy, defined as gestational diabetes or a hypertensive disorder in pregnancy; 2) Compare the impact of NCDs in pregnancy on pregnancy outcomes and maternal and infant NCD outcomes at 6 months postpartum between HIV-infected and HIV-uninfected women; 3) Develop networks and capacity for further collaborative research on HIV and NCDs in pregnancy and postpartum involving South African and US institutions. Capacity building will include mentoring graduate students, convening a symposium on NCDs and HIV in pregnancy that brings together experts from the US and South Africa, and the development of a Scientific Advisory Board to advance NCD and HIV perinatal research priorities in LMICs. Our multidisciplinary team of HIV and NCD experts from the US and South Africa are ideally positioned to carry out the proposed project which will provide preliminary data for future proposals and a robust platform for research on HIV and NCDs to improve maternal and child health in LMICs.